Kareo / Tebra Billing Services

Kareo and Tebra are the same platform under two names, and it is the system independent solo and small-group practices most often run themselves. That is the real situation we are hired into: capable software, and nobody whose actual job is billing.

Most Tebra rejections are a settings problem, not a claims problem

This is the single most useful thing to know about billing in Kareo or Tebra. A large share of rejections never had anything to do with the visit. They come from configuration entered once during setup and never checked again, and they will reject every matching claim forever until someone fixes the record.

The usual culprits are specific and findable. A practice name longer than the 60 characters the claim format allows. A group NPI or tax ID that does not match what the payer has on file. An address that is a P.O. box, or a ZIP without all nine digits, where a physical address is required. An individual provider NPI that does not match the NPPES registry. A taxonomy or specialty that does not match how the provider is credentialed. A billing NPI or tax ID override set at the payer level and then forgotten. An insurance program type chosen wrongly — a Medicare plan set up as Blue Cross, for instance. A payer connection or clearinghouse that does not match the enrollment actually completed, or a claims address that has since changed.

The first thing we do on a Kareo or Tebra account is audit every one of those records against the payer's own data. It is unglamorous and it typically removes a standing block of rejections in the first week.

Approved encounters, and the ones nobody approved

In Tebra a charge lives as an encounter, and an encounter does not become a claim until it is approved. Draft encounters sit quietly. They do not age, they do not alarm, and they are not in your A/R because they were never billed. In a practice where the provider is also the person approving encounters between patients, this is where money goes.

We reconcile encounters against the appointment schedule on a fixed cycle. Every completed visit becomes a claim or gets an explanation. Claims are submitted within 24 hours of the charge and our clean-claim rate is 98%.

Rejections and denials are different problems

A rejection was stopped before the payer ever saw it — usually at the clearinghouse, usually for a format or identifier error. There is no adjudication, no remittance and no appeal right. Crucially, there is also no record at the payer that you filed, so timely filing keeps running while the claim sits in your system looking submitted.

A denial is an actual decision you can appeal. Different cause, different fix, different clock. We work rejections the same day and denials within 48 hours, and we report them separately so you can see which problem you actually have. Insurance aging is worked at 25 to 30 days. See denial management.

ERA enrollment is per payer, and it is usually half done

Electronic remittance has to be enrolled payer by payer. Practices complete the big three, run out of patience, and leave a long tail of payers paying by paper. Those payments post late and by hand, denials on them are discovered weeks after the fact, and secondary claims go out slowly because the primary remittance is sitting in an envelope.

We finish the enrollments, post payments accurately against contracted rates, and reconcile. If you would rather not handle the paper at all, we receive practice mail and deposit checks — see mail handling and deposits and EOB vs ERA.

Patient balances, which are a growing share of your revenue

High-deductible plans have shifted a real portion of collections onto the patient, and patient balances are the ones a busy small practice chases last. Statements go out irregularly, nobody follows up on the second one, and the balance is written off by default rather than by decision.

We run statements on a schedule, follow up on balances courteously, and set up payment plans where they will actually collect more than a demand letter. See patient statements and collections and patient collections best practices.

A billing department, at the size a small practice can afford

The honest problem with a one or two provider practice is that a full-time certified biller is expensive and a part-time one has no backup. When that person is on vacation, billing stops. When they leave, it stops for a month. Our US and India team means work continues overnight and there is never a single point of failure.

Insurance verification, coding, credentialing and monthly Practice Performance Reports are included rather than billed as extras. Compare the real numbers in in-house vs outsourced billing and pricing.

Why practices on Kareo / Tebra choose Synergy

You keep Kareo / Tebra. You keep your logins, your templates, your schedule and your data. Nothing is migrated and nothing new is purchased — we work inside the system you already run. What changes is who works it: a 98% clean-claim rate, claims out within 24 hours, denials worked within 48 hours, insurance aging worked at 25–30 days, and free insurance verification, coding, credentialing and monthly Practice Performance Reports. Twenty years in business, a US and India team so your queues move overnight, HIPAA-compliant throughout, a 30-day free trial and a 90-day money-back guarantee. We're not your billing service — we're your Billing Department.

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